Breastfeeding Unplugged
Breastfeeding Unplugged
I'm Home From the Hospital, Now What?
Well momma, you did It! You got through labor and delivered this perfect little baby. After a day or two, you’re on your way home from the hospital or you're getting settled in after a home birth, only just realizing that you have absolutely no idea what you’re doing!
That's what we are going to talk about today. How can you be prepared to breastfeed your newborn when you get settled back Into your everyday environment? What can you expect in those first days and weeks? What should you look out for to make sure that baby is feeding well or if she or he is having a bit of trouble?
On the show for this episode is Adrienne Koznek, a Portland, Oregon-based International Board Certified Lactation Consultant with Nest Collaborative and the mom of one eight-year-old boy. Adrienne’s own personal breastfeeding journey started off quite difficult, but she was able to go the distance and she now helps families all over the country on their own path through early parenthood.
Join us for today's episode, you won't want to miss It!
[Intro] Breastfeeding Unplugged. Welcome. Welcome. Welcome mamas and mamas-to-be. A podcast dedicated to helping moms navigate their way through the tricky world of breastfeeding. Breastfeeding Unplugged. Breastfeeding Unplugged. Hello mamas and mamas-to be-and welcome to another episode of Breastfeeding Unplugged. I'm your host Amanda Gorman of Nest Collaborative. And this week, we will be exploring those tricky first few days at home from the hospital with your new little love, or at home, for those of you who birth at home, birthing center, or wherever you birth. I remember giving birth to my own children. And to be honest, it all feels a bit like a blur. You kind of- or I, I at least got through labor and delivered this beautiful, perfect little baby and was completely riding high on oxytocin and all the feels that go with being a new mom. You know, if you do give birth in a hospital, you're sometimes whisked away to a postpartum room. If you're in a hospital that doesn't, you know, room-in and some nurses will come just to make sure you're comfortable as humanly possible and offer kind of the basics in teaching you about newborn care. A lactation consultant may pop in and give you a few pointers on feeding. Then after a day or two, you're on your way home with your little babe, only just realizing that you may have no idea what you're doing in some cases. So that's what we're here to talk about today. How can you really be prepared to breastfeed your newborn when you get home from your birthing spot? Or when you're nestling in as a family? What can you expect in those first few days, in those first few weeks, and what you really should look out for to make sure that baby's feeding well, or how can you assess if he or she is having a little bit of trouble? With me today is Adrienne Koznek, Portland, Oregon based International Board Certified Lactation Consultant. She's on our team at Nest Collaborative and she's a mom of a really adorable eight year old boy. Adrienne's own personal breastfeeding journey started off a little difficult, but she was able to go the distance and now she helps our families all over the country as well as her- in her own practice On Their Path Through Parenthood. Adrienne, welcome to the show. It is fantastic to have you with us today.
Adrienne Koznek:It's good to be here. Thank you.
Amanda Gorman:Good. I wanted to get started talking a little bit about some numbers. According to the CDC 84% of lactating parents start off breastfeeding, but only 25% are still exclusively breastfeeding at that six month mark. You were almost one of those parents. So can you tell us a little bit about your personal experience?
Adrienne Koznek:Yeah. So I was definitely one of those people who spent a lot of time preparing for the birth, and figuring out how I could make my birthing experience be what I want it to be. And I very distinctly remember reading a breastfeeding book and thinking,"Okay, I'll figure this out after the birth." I'll figure this out when he's here. Um, and I learned pretty quickly that that wasn't the best idea. And that I should have spent some more time thinking about what I was going to be spending a lot more time doing, then spending so much time, you know, creating this birth plan in my head. Um, so, yes, my breastfeeding journey was really tough in the beginning, because of a lot of different reasons. One, I didn't know very much about breastfeeding, I had limited experience with it. My older sister had a baby, but he was only four months old. So that was the extent of my breastfeeding experience was seeing my sister breastfeed only for four months at that time. And she was doing very well and I couldn't understand why I wasn't doing it as well as she was. Um, so I saw a lot of different lactation consultants at the hospital that I gave birth at with varying degrees of success. And it actually wasn't until I saw a person who was in private practice that I was really able to kind of get on track and get the get the diagnosis that I need- that I needed of my baby had a tongue tie, and it was largely ignored and overlooked until I saw somebody in private practice who was able to get me on the right path. And then once I had the knowledge and the confidence in myself to know what to do going forward, we went on to breastfeed for over two years. So it ended up having a very lovely ending.
Amanda Gorman:That is, and that truly is a success. That is, that's great. Yeah, no, thank you for sharing that. I didn't know that whole story, so. Um, so let's jump in with some questions. Well, successful breastfeeding from day one is, you know, kind of equal parts, education and preparation. What do you think parents can do before they have their baby to really set them up for breastfeeding success once baby arrives?
Adrienne Koznek:I think the two biggest things that parents can do is either take a breastfeeding class, or have a prenatal breastfeeding consult with an International Board Certified Lactation Consultant. Because knowing what to expect and knowing what to look for, especially knowing what's normal, is, I think, the most important takeaway. Um, I talk a lot to parents about how so much of breastfeeding and so much of just parenting a newborn is very like pathologized. And that we're always looking for something like to be going wrong. And we are often told that common newborn behaviors is something wrong. And so knowing what is normal is going to help you when your baby comes, because then you'll then you'll know like, oh, okay, I don't need to call the pediatrician for this, or I don't need to call the advice nurse for this, like, I know, this is a normal thing that babies do. So getting that information ahead of time, either from a class or from a consult. Some people like to read books, and I think that can be a really useful thing. But if you're pressed for time, or books don't really, that's just not how you learn about things, then meeting with somebody either virtually or sort of face to face. I guess that's not really happening right now. But if it were, I think that that can make all the difference, honestly.
Amanda Gorman:Absolutely. And it's something I wish I had known is, is that that's what the research actually says, is shown to be beneficial. Women who have more comprehensive education prenatally are found to be more successful in meeting their goals. So I think that's great to share with everyone.
Adrienne Koznek:And increasing the duration of breastfeeding to like, not only do they start out- more often they start out breastfeeding, but they continue to breastfeed for even longer.
Amanda Gorman:Absolutely. Is there anything that one can do while they are, if they're at the hospital or birthing center to get ready for the transition home with respect to breastfeeding?
Adrienne Koznek:I think that everybody should leave the hospital knowing what to be looking for in terms of what to track, how to track the wet diapers, how to track the dirty diapers. And if they're on a feeding plan that includes giving any sort of supplementation, any kind of extra milk, they need to leave the hospital knowing what the game plan is for that feeding plan. They need to know is this going to be for three days? Is this going to be for the next 24 hours and not just set, not just be told you have to do this and then not know when they're supposed to stop or continue. I also believe strongly that families should leave their birthing spot knowing when they're going to be checked in on again, and not just the you know, two day newborn checkup. But when is, when are they going to see the feeding expert? When are they going to see the lactation consultant again, to make sure that things are going the way that they're supposed to be going?
Amanda Gorman:Mm hmm. Absolutely. So families are in the hospital, baby is latching great. You know, the hold, the positioning is fantastic. Mom's feeling great. But then family gets home and things kind of derail, and they're not going as well as they were going. What should parents do?
Adrienne Koznek:First of all, they should not panic, because I think many many, many, many people discover this. I think that the reason why this happens is a couple of reasons. Um generally speaking like around day three, day four, that's when the white milk is starting to transition, which comes with a lot of hormones and a lot of physical changes and a lot of emotion comes up. And babies are also kind of like starting to come online and they're like looking around the universe and thinking where the heck am I this is not what I'm used to. So kind of everybody loses their mind. In those- at like around day three. It's very common. So I think that knowing that is helpful, and knowing who to call. So do you like, do you have your lactation consultant's phone number? Do you have a trusted friend or a family member who knows about caring for a baby? And knows, you know, do you have somebody that you can talk to about it? And then what I would advise not doing is immediately jumping on the internet and googling things. Because I know I personally find that to be very overwhelming when trying to find out parenting advice. So you know, knowing your trusted sources, who can you reach out to? And then execute a plan from there.
Amanda Gorman:Mm hmm. Absolutely. I think, you know, a large percentage of families are sent home from the hospital with formula, or we know that moms magically get formula appearing in their mailboxes when they're pregnant. What should parents do with it if they intend to breastfeed?
Adrienne Koznek:If they intend to breastfeed, then there's not really anything that they need to do with it. I think, I think there's a lot of different very, like, you can have varying opinions on the validity of having it sent home from the hospital with you or sent to you in the mail. Um, I, statistically, it's not necessarily likely to be needed in the first week, especially if somebody is off to a good start breastfeeding. So if you have it because it was sent to- if it was sent home with you from the hospital, were you given a feeding plan? Were you told that you needed to use this and if you were told you needed to use it, ask about can you be using your own milk first to supplement. When you're giving extra milk, you know, the the hierarchy of giving extra milk for babies from the World Health Organization is always start with the breastfeeding parent's milk first, and then, you know, pumped milk if it is. And then bank's donor milk, and then milk from a family or trusted friend. And then formula. So there's a lot of like extra milk kind of in between mom- mom's milk, the breastfeeding parent's milk, and then the formula. So just knowing when it's supposed to be used for. Formula is a it's a medical intervention, it's a tool, right? And so when the tool needs to be used, we need to be using it correctly.
Amanda Gorman:Absolutely. And I think you bring up a lot of good information that not every family has going into this the first time. What is that hierarchy? Certainly I know, it didn't even dawn upon me to pump and give my own milk if I couldn't actually get baby to take it from the breast. I think more and more hospitals have banked and donor milk available. More and more states have banks available, more and more insurance companies are covering donor milk. And this might not be something that your pediatrician necessarily knows about. Because a lot of- on this has changed in the last decade, five to 10 years. So I think this is great information for moms to know about. So thank you. We hear a lot from families we see who say that their friend's breasts got huge when their milk came in. Is that always the case?
Adrienne Koznek:That's something that I talk about a lot with parents too, is because they are surprised if it's not happening to them. Because we do he- you know, like we see in the movies and all these things about like painful engorgement and rock hard breast and all of these things. And engorgement is actually a sign that something may be not- may not be going right. So no, it doesn't have to be part of it. A baby who's nursing well, and a baby who's removing milk well, regularly and frequently, at least 10 to 12 times in 24 hours. They're going to kind of make the transition from the colostrum to the white milk more smooth, and it'll be this kind of more smooth transition. It's more within the realm of normal to feel kind of heavy breasts or kind of fuller, or maybe a lot fuller, but not necessarily painful or hard or swollen. Those are signs that maybe the milk hasn't been getting removed as well as maybe we think we do think the baby was doing, which can happen for a variety of reasons. But a baby who's nursing well is avoiding engorgement.
Amanda Gorman:Thank you for clarifying that. So we don't all have to go through torture. That's good to know. Okay, so we talked that's, you know, the engorgement side. Let's talk about nipple care, cracking, and bleeding. Are these common and what can women do for themselves when this happens?
Adrienne Koznek:Yes, it is common, but common does not equal normal. And so I think this is another one of these things that is kind of in the cultural zeitgeist in society about. It's this expected thing, maybe it's like a rite of passage for breastfeeding, that you have to have these cracked nipples and bleeding, and all this terrible things- all these terrible things. And it's a sign that something's wrong. It's a sign that there's something wrong with the latch. And it could be positioning, it could be anything from positioning, to something going on with the baby's oral structure, to how the birth was. So it's always important to identify what is the issue causing the problem, and then treating treating the problem, right. So cracked nipples are a symptom of something. So if you find that you're having that or if you're having like, continued soreness, or bleeding or damage, see a lactation consultant. Figure out where that's coming from. And there's different treatments that I like to use for nipple damage, depending on the severity of it, depending on the parent. So that's why having that good, like individualized plan for what's gonna best heal your nipples is that's good information for parents to have.
Amanda Gorman:Great. So before we take a break, let's talk a quick minute about mastitis. Can you tell us what that is, and why would we get it?
Adrienne Koznek:Mastitis is a breast infection and it comes from milk stasis, which basically just means milk sitting in the breast. It can also happen when there's bacteria introduced into the breast by way of cracked nipples, or when the tissue has been compromised. So there's two different types of mastitis. There's viral mastitis and there's bacteria mastitis. Um, more often than not mastitis gets treated with antibiotics and more often than not, it actually doesn't need antibiotics. So it's always really, really important to figure out what is causing the mastitis. Is it this plugged duct that is now inflating the breasts? Do you have red streaking on your breasts? Is it painful to the touch? Hot to the touch? Is it only in one breast or is it in to breasts, etc? So really sussing out what the symptoms are, can be really helpful in treating it. So the most common reason I see mastitis in the first couple of days or first couple of weeks is because the milks not being removed properly. And that goes back to the basics of is the baby latched well? Are they transferring milk and if you are ending up with mastitis, then your baby is likely not latched well, and they're likely not transferring milk well.
Amanda Gorman:Great. And thank you for mentioning kind of the the importance of getting to the root of the problem. Because as you mentioned, in some cases, you can clear up mastitis with antibiotics but you're likely to see it again if you don't correct what's driving it. So-
Adrienne Koznek:Right yeah, and even more so everything that we know about the the risks associated with antibiotics and what it does to our gut and to our gut health. Obviously, the less we use it, the better, so if it can be avoided, then that's certainly ideal.
Amanda Gorman:Well, this is such great information. Adrienne, we're going to take a quick break, but come back and I would like to talk about some of the common roadblocks mom face when they first get home. So stay tuned. Like many of us, I've been trying to use less plastic in our household. I just tried Shambar, a new sulfate free shampoo and conditioner in a bar and it blew me away. Here's what I loved about Shambar. No yucky stuff, no synthetic fragrances or harsh color feeding sulfates. As a mom It feels good to know that I'm using a safer product, that my hair is healthier, and it's saving me more trips to the salon for coloring and more highlights. Each Shambar replaces two 18 ounce single use plastic bottles. It's a family business and for every order they donate a month's worth of soap to a family in need. What a relevant give back to make sure all families have the resources that they need. A win win. Get your first bar absolutely free when you use the code first free. All one word. First Free on one of their flexible, cancel anytime, super easy subscriptions. Find out more at Shambar.com. Hi mamas we are back with Portland based IBCLC Adrienne Koznek, who is with us today to chat through what breastfeeding moms can expect during those first few days after coming home from the hospital or wherever baby arrives from. So just to jump right to the nitty gritty, most postpartum nurses and pediatricians might tell you that poop is a great indicator of how your baby's feeding. So talk us through that, Adrienne.
Adrienne Koznek:Yes. So the- one of the biggest things that I hear from parents is they feel worried that their baby's not getting enough milk because they can't measure how much milk they're getting. They can't physically see how much milk they're getting when they're drinking from the breast. So I get very excited to tell them, What if I told you there's a way that you can know that doesn't have to be measuring it from you know, outside of the breast?" S the best way to do that is b counting the diapers. That's wh in the hospital, they have yo track the diapers, it's wh tracking it for the first coupl of weeks while things are ar getting established, it can b really a useful tool. And so th number of poopy diapers and we diapers that they're having in 24 hour period is the greates indicator that they're gettin enough milk, because what goe in must be coming out. So i we're having really adequate we diapers, which in the firs couple of days can be based o the number of days that they'r alive. So day one, they shoul be having one wet diaper, on poopy diaper. Day two, two we diapers up to about day five And then typically what we wan to see is about six to eight we diapers. And about three to fiv poopy diapers that are goo size, and I'm holding up m fingers to make about like half dollar size right now That's considered a good sized good sized poop. And that's wha we want to be looking for to because oftentimes, we're no taking babies to get weighe every single day. And certainly I don't necessarily think tha we need to do that. So in th absence of getting a weight o them very regularly, countin those poops and those pees is great way to be making sure tha they're on the right track
Amanda Gorman:Awesome. And just for any mamas-to-be who are listening and have never seen what breastfed babies poop looks like, do you want to touch on that real quick?
Adrienne Koznek:Um, people always get really funny when I ask them that, like, it's this odd question. And I just think nothing of it, because they spend so much time talking about what poop looks like. Yes, so many parents are surprised that it's not solid or formed, it doesn't look like I almost said like regular human poop. But I definitely don't mean that. It doesn't look like what our poop looks like, it's going to be very runny, it's going to be kind of liquidy, it's going to be any variation of like yellow, maybe some orange, sometimes there's some green in there. If they are getting some formula, then it can sometimes look a little bit more brown. That's that's what the breast milk poop should look like after it has transitioned from the meconium poops. So when you're in the hospital, they're going to be very excited to show you all of those meconium poop diapers that we want to get out of the baby as quickly as possible. And then it should start to transition over the next few days to start looking more yellow, seedy, kind of runny. Sometimes there can be variations of green that are within the realm of normal. I'm in the Pacific Northwest. So I like to tell people colors that you see on a tree around here would be colors that are normal in breast milk poop.
Amanda Gorman:I like that.
Adrienne Koznek:Yeah.
Amanda Gorman:So what about sleep? What is a good kind of feeding, sleeping schedule during those first few days?
Adrienne Koznek:I'm hesitant to call anything a schedule, because babies need to nurse anywhere from 10 to 12 times in 24 hours. And that could be every couple of hours, or it could be every hour for a chunk of time. And then maybe they sleep for three hours. It's not going to be this like straight line linear, they eat this exact amount at these exact periods of time. So in the first couple of days, what I tell parents to do is be waking them to feed if they're not waking on their own. Many babies do not wake on their own to feed for the first couple of days, that's normal, especially if they've had a particularly arduous birth or if they received a lot of like interventions in labor and in delivery. It can make babies sleepy. So we wake them to feed and I kind of aim for this like two and a halfish hour time period. But what's most important is to be knowing what cues to look for for baby and following those cues. So typically, babies will start to show some early feeding cues and they may start kind of stirring in their sleep a little bit and then that's a great time to get them ready to feed and get them really awakened with their eyeballs showing so they're out of that sleep cycle and then bring them to the breast. In the first couple of days, most babies will feed and then they'll fall asleep. And then we wake them up and we feed them and then they fall asleep. And that's just, that's just their little lives for a short duration of time.
Amanda Gorman:Very, very helpful. So what common problems exist with breastfeeding early in those first few days that moms might want to know about ahead of time?
Adrienne Koznek:Definitely the biggest complaints or concerns that new parents have in those first couple of days are my nipples are sore, or they are painful. What can I do about that? So that's definitely one of the most common things and like I said before, common doesn't mean normal. It's normal to have some tenderness in the first couple of weeks. Two weeks is pretty generous, I would say. It's normal for there to be transient tenderness. It's not normal, for there to be pain. Pain is a sign that something is wrong. So where we have this nipple soreness, the simplest explanation is always going back to the positioning, going back to making sure that the breastfeeding parent has really good positioning of how they're holding the baby. Is the baby close enough to nurse well? Do they have a good, deep, wide open latch? And then does that feel okay? So that's always kind of where we start. Other common complaints that come up are engorgement or painful breast once the milk has started to transition. And so we treat that with a variety of different things, kind of depending on what's most appropriate for the dyad. Um, and let's see. Those are those are like, the biggest ones that I that I have is my baby's latch hurts me, why is it hurting? So we figure out is it positioning. Is my- is the mom- is the breastfeeding parent doing everything on their end that they need that they need to be doing correctly. And if it's still painful, if it's still hurting them, then we have to look at the baby, we have to be looking at what's going on on baby's end that is contributing to this pain and this discomfort that doesn't have to be considered a normal part of breastfeeding.
Amanda Gorman:One other thing I hear you all talk about in those early days is cluster feeding. Maybe you could share a little bit about that. Because I know that's fairly common as well.
Adrienne Koznek:Yeah, cluster feeding is basically it's a time where baby is doing a lot of things all at once. They- sometimes parents will find themselves sitting on the couch for four hours at a time and the baby just wants to nurse and then they want to stop but the newborn wants to nurse again, and it can be every hour on the hour for a chunk of time. And this is normal, it is not a sign that your milk supply is low or is not enough. It is oftentimes they do it because they're either like going through a cognitive leap or maybe a physical growth spurt. They may be like putting in an order to increase your milk supply. Or they may just be in that particular time of day. And cluster feeding is common- commonly happens in the late afternoon to like early evening time. And it's just this time where you got to you know, have your book ready on the couch and have a seat and you know, know that it will pass.
Amanda Gorman:Very helpful. So if if moms are feeling anxious at all, or hope- hopelessly, completely at a loss, who do they reach out to? In you know, in other words, what resources are available for them?
Adrienne Koznek:I think that it's important for parents to understand that International Board Certified Lactation Consultants are the gold standard for breastfeeding care. So when you're looking for the experts in breastfeeding and chestfeeding and lactation, it is the lactation consultants. So when there is a breastfeeding issue to be had come see, you know, one of us and we can help you through that. And if it feels like everything is hard, and it feels like it's beyond what is normal for you. If you're not feeling like your heads right. Or if you're feeling like you have some depression or sadness or maybe some baby blues that may or may not be related to breastfeeding, or if you're feeling anxious, and that doesn't feel right to you. Um, I always recommend parents find support groups like Postpartum Support International in the Portland area. There's the Baby Blues Connection and I think now that so many things are online, you can probably- they, they're probably providing peer support all over. And so I- the reason why I bring that up as a resource is because I think that the breastfeeding parents and the partner as well, like, their mental well being is just as important as anything else that we give them information about. So there's always going to be support, there's always going to be help, and we will always point people in the right direction to get the support that they need.
Amanda Gorman:Good. That's great. Well, Adrienne, this has been a really great chat. And it certainly brought me back to my early days with my own littles. Breastfeeding is it was hard for me, it is hard for many, it doesn't feel like there really is enough support out there for moms to get when they really need it. And to help them be where they want to be for their journey. And that is really why we exist. And we love IBCLCs like you who are helping our moms gain more confidence and build those bonds with their babies and go on to have really fantastic breastfeeding experiences. So thank you for what you do. And is there anything else you'd like to add before we close?
Adrienne Koznek:I just think it's really, really good for new parents to know that they're not alone, in any sense of the imagination, especially now. Now more than ever, we're all in such this like isolated place. And new parents, especially, I think, feel that very physically and emotionally this isolation, and they're not alone. And if there is a concern that they're having that, you know, we we answer the questions. We are, we're there to help them figure out if there even is anything wrong. And we're here to point out like, yeah, things are going really well and here's how you can know that things are going well. And sometimes it can just be really nice to hear that from somebody who is kind of on the outside, you know, who can objectively say, yeah, things are going really well. And you're doing it, you're doing the thing. So yeah, they're not alone.
Amanda Gorman:No, I love that. Thank you. Thank you so much. I'm super appreciative of all your knowledge. If our listeners want to get in touch with you, what is the best way to do that?
Adrienne Koznek:Through Nest Collaborative. That's the care that I am providing these days.
Amanda Gorman:Yes, she is there and is working, working a lot with a lot of our moms that we we love that, thank you. Awesome. Well, mamas and mamas-to-be that is our episode for today. As always, the show was created by our experts really just for you. So if there is a question you have, or a topic you'd like to be explored, that's why we're here. So send us a message on Instagram or Facebook@breastfeedingunplugged, or visit our website at breastfeedingunplugged.com for more information and a transcript of today's show. It's been fantastic sharing this half hour with you and we will hopefully see you next week. Until then it's me Amanda signing off. Boo bye. [Outro] Breastfeeding Unplugged.